俗名心跳。心为火脏。无血以养之。则火气冲动。是以心跳。安神丸清之。归脾汤加麦冬五味子以补之。凡
思虑过度。及失血家去血过多者。乃有此虚证。否则多挟痰瘀。宜细辨之。
心中有痰者。痰入心中。阻其心气。是以心跳动不安。宜指迷茯苓丸。加远志菖蒲黄连川贝母枣仁当归
治之。朱砂安神丸。加龙骨远志金箔牛黄麝香治之。
又有胃火强梁。上攻于心。而跳跃者。其心下如筑墙然。听之有声。以手按其心下。复有气来抵拒。此为心
下有动气。治宜大泻心胃之火。火平则气平也。泻心汤主之。或玉女煎加枳壳浓朴代赭石旋复花以降
之。再加郁金莪术以攻之。使血气火三者皆平。自不强梁矣。
悸者。惧怯之谓。心为君火。君火宣明。则不忧不惧。何悸之有。心火不足。则气虚而悸。血不养心。则神浮而
悸。仲景建中汤。治心气虚悸。炙甘草汤。治心血不足而悸。今则以养荣汤代建中。以归脾汤代炙甘草。一
治气虚。一治血虚。又有饮邪上干。水气凌心。火畏水克而悸者。苓桂术甘汤治之。失血家多是气血虚悸。
水气凌心者绝少。又曰正虚者。邪必凑之。凡是怔忡惊悸健忘恍惚。一切多是痰火沃心。扰其神明所致。
统用金箔镇心丸主之。
惊者。猝然恐惕之谓。肝与胆连。司相火。君火虚则悸。相火虚则惊。盖人之胆壮则不惊。胆气不壮。故发惊
惕。桂枝龙骨牡蛎甘草汤治之。恐畏不敢独卧者。虚之甚也。仁熟散治之。又凡胆经有痰。则胆火上越。此
胆气不得内守。所以惊也。温胆汤。加龙骨牛黄枣仁琥珀柴胡白芍治之。复有阳明火盛。恶闻人声。闻木
音则惊者。此内经所谓气并于阳。故发惊狂者也。乃肝胆木火脾土。法宜大泻阳明之火。大柴胡汤治之。
当归芦荟丸亦治之。血家病惊。多是阳明火盛。病虚惊者。亦复不少。用以上诸方。须兼顾血证。以尽其化
裁。勿执桂甘龙牡等汤。而不知宜忌也。
Commonly known as palpitations. The Heart is the organ of Fire. Without blood to nourish it, the Fire Qi will surge impulsively, thus causing palpitations. Anshen Wan (Calming the Spirit Pill) is used to clear [the heat]. Guipi Tang (Restore the Spleen Decoction) with added Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus) is used to tonify [deficiency]. Whenever excessive mental exertion occurs, or in patients who have lost blood excessively, this deficiency syndrome arises. Otherwise, phlegm and blood stasis are often involved, requiring careful differentiation.
When phlegm resides within the Heart, phlegm enters the Heart, obstructing the Heart Qi, thereby causing restless palpitations. Zhimi Fuling Wan (Pill to Eliminate Phlegm with Poria) is indicated. It should be treated by adding Yuanzhi (Polygalae Radix), Shichangpu (Acori Tatarinowii Rhizoma), Huanglian (Coptidis Rhizoma), Chuanbeimu (Fritillariae Cirrhosae Bulbus), Suanzaoren (Ziziphi Spinosomi Semen), and Danggui (Angelicae Sinensis Radix). Alternatively, Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill) can be used, treating it by adding Longgu (Fossilia Ossis Mastodi), Yuanzhi (Polygalae Radix), Jinbo (Gold Leaf), Niuhuang (Bovis Calculus), and Shexiang (Moschus).
There are also cases where Stomach Fire is vigorous and aggressive, attacking upward into the Heart, causing jumping palpitations. The area below the heart feels like a wall being built; listening reveals sounds, and pressing the area below the heart with the hand meets resistance from Qi. This is termed "moving Qi" below the Heart. Treatment should focus on vigorously purging the Fire of the Heart and Stomach. Once the Fire is pacified, the Qi becomes peaceful. Xiexin Tang (Decoction to Drain the Heart) is the primary formula. Or, Yunu Jian (Jade Woman Decoction) with added Zhike (Aurantii Fructus), Houpo (Magnoliae Officinalis Cortex), Daizheshi (Haematitum), and Xuanfuhua (Inulae Flos) is used to direct downward. Additionally, Yujin (Curcumae Radix) and Ezhu (Curcumae Rhizoma) are added to attack [the pathogen]. This ensures that Blood, Qi, and Fire all become balanced, and the aggression ceases naturally.
Palpitation (Ji) refers to fear and timidity. The Heart governs Ministerial Fire (Jun Huo). When Ministerial Fire is bright and clear, there is no worry or fear, so how could there be palpitation? If Heart Fire is insufficient, Qi deficiency leads to palpitation. If Blood fails to nourish the Heart, the Spirit floats, leading to palpitation. Zhang Zhongjing’s Jianzhong Tang (Establish the Middle Decoction) treats palpitation due to Heart Qi deficiency. Zhigancao Tang (Honey-fried Licorice Decoction) treats palpitation due to Heart Blood insufficiency. Currently, Yangrong Tang (Nourish the Prosperity Decoction) replaces Jianzhong Tang, and Guipi Tang (Restore the Spleen Decoction) replaces Zhigancao Tang. One treats Qi deficiency, the other treats Blood deficiency. There are also cases where fluid retention pathogens interfere upward, and Water Qi overwhelms the Heart; fearing the control of Water over Fire, palpitation occurs. Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Glycyrrhiza Decoction) treats this. Patients who have lost blood mostly suffer from Qi and Blood deficiency palpitations; cases of Water Qi overwhelming the Heart are extremely rare. It is said that when Righteous Qi is deficient, Pathogenic factors must invade. All conditions such as constant palpitations (Zhengchong), startled palpitations (Jingji), forgetfulness, and confusion are mostly caused by Phlegm-Fire flooding the Heart and disturbing the Spirit. Jinpiao Zhenxin Wan (Gold Foil Calming the Heart Pill) is uniformly used as the main formula.
Startle (Jing) refers to sudden terror and alertness. The Liver connects with the Gallbladder, which governs Ministerial Fire (Xiang Huo). Deficiency of Ministerial Fire (Jun Huo) causes palpitation; deficiency of Ministerial Fire (Xiang Huo) causes startle. Generally, if a person’s Gallbladder Qi is strong, they do not startle. If Gallbladder Qi is not strong, startle and alertness occur. Guizhi Longgu Muli Gancao Tang (Cinnamon Twig, Dragon Bone, Oyster Shell, and Licorice Decoction) treats this. Fear so severe that one dares not sleep alone indicates extreme deficiency. Renshu San (Renshu Powder) treats this. Furthermore, whenever there is phlegm in the Gallbladder Meridian, Gallbladder Fire flares upward. Because Gallbladder Qi cannot remain internally secure, startle occurs. Wendan Tang (Warm the Gallbladder Decoction) with added Longgu (Fossilia Ossis Mastodi), Niuhuang (Bovis Calculus), Suanzaoren (Ziziphi Spinosomi Semen), Hupo (Succinum), Chaihu (Bupleuri Radix), and Baishao (Paeoniae Radix Alba) treats this. There are also cases where Yangming Fire is excessive, causing aversion to human voices and startle upon hearing wooden sounds. This corresponds to what the *Neijing* describes as Qi merging with Yang, thus causing startle and mania. Involving the Wood and Fire of the Liver and Gallbladder, and the Earth of the Spleen, the method should be to vigorously purge Yangming Fire. Dachaihu Tang (Major Bupleurum Decoction) treats this. Danggui Luehua Wan (Angelica and Aloe Pill) also treats this. For blood-deficient patients suffering from startle, it is mostly due to Yangming Fire excess. Cases of deficiency-type startle are also numerous. When using the aforementioned formulas, one must take into account the blood syndrome to fully utilize modifications. Do not rigidly adhere to formulas like Guizhi Gancao Longgu Muli Tang without knowing indications and contraindications.